JP2010042295A - 外科用ステープリングデバイスのためのツールアセンブリ - Google Patents
外科用ステープリングデバイスのためのツールアセンブリ Download PDFInfo
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07271—Stapler heads characterised by its cartridge
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07285—Stapler heads characterised by its cutter
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2931—Details of heads or jaws with releasable head
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2933—Transmission of forces to jaw members camming or guiding means
- A61B2017/2934—Transmission of forces to jaw members camming or guiding means arcuate shaped guiding means
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2933—Transmission of forces to jaw members camming or guiding means
- A61B2017/2936—Pins in guiding slots
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2944—Translation of jaw members
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Abstract
【課題】組織を効果的に把持、操作または固定するために操作され得る旋回ジョーを有する内視鏡外科用ステープリングツール部材を提供する。
【解決手段】ジョーの各々が近位端および遠位端を有し、第一のジョーが間隔を開けた位置と接近位置との間で第二のジョーに対して可動である。第一のカム従動子および第二のカム従動子は、第一のジョーに支持される。接近部材は第一のジョーに対して可動であり、第一のカム従動子および第二の従動子を係合するように位置付けられたカム表面を備える。接近部材は、第一のカム従動子および第二のカム従動子に対してカム表面を移動させて、間隔を空けた位置から接近位置への第一のジョーおよび第二のジョーの移動をもたらすために、第一のジョーに対して可動である。カムチャネルは、第一のジョーおよび第二のジョーの接近末端の接近の前に、第一のジョーおよび第二のジョーの遠位端を接近させるように構成される。
【選択図】図1
【解決手段】ジョーの各々が近位端および遠位端を有し、第一のジョーが間隔を開けた位置と接近位置との間で第二のジョーに対して可動である。第一のカム従動子および第二のカム従動子は、第一のジョーに支持される。接近部材は第一のジョーに対して可動であり、第一のカム従動子および第二の従動子を係合するように位置付けられたカム表面を備える。接近部材は、第一のカム従動子および第二のカム従動子に対してカム表面を移動させて、間隔を空けた位置から接近位置への第一のジョーおよび第二のジョーの移動をもたらすために、第一のジョーに対して可動である。カムチャネルは、第一のジョーおよび第二のジョーの接近末端の接近の前に、第一のジョーおよび第二のジョーの遠位端を接近させるように構成される。
【選択図】図1
Description
本出願は、2003年10月4日に出願された、Tool Assembly For
Surgical Stapling Deviceと題された、米国仮出願番号60/416,056号からの優先権を主張し、これらの内容の全体が、本明細書中において参考として援用される。
Surgical Stapling Deviceと題された、米国仮出願番号60/416,056号からの優先権を主張し、これらの内容の全体が、本明細書中において参考として援用される。
(背景)
(1.技術分野)
本開示は、一般的に、固定具を操作し、そして/または固定具を組織に適用するための外科用ツールアセンブリに関係する。より詳細には、本開示は、組織の改善された締め付けおよび操作を容易にするための独特の接近機構を備える一対のジョーを有する外科用ツールアセンブリに関係する。
(1.技術分野)
本開示は、一般的に、固定具を操作し、そして/または固定具を組織に適用するための外科用ツールアセンブリに関係する。より詳細には、本開示は、組織の改善された締め付けおよび操作を容易にするための独特の接近機構を備える一対のジョーを有する外科用ツールアセンブリに関係する。
(2.関連技術の背景)
ツールアセンブリの対向するジョー構造間で組織を締め付け、その後、締め付けられた組織を固定するための外科用ステープラーおよびツールアセンブリは、当該分野において周知である。これらのデバイスは、固定された組織を切開するためのナイフを備え得る。
ツールアセンブリの対向するジョー構造間で組織を締め付け、その後、締め付けられた組織を固定するための外科用ステープラーおよびツールアセンブリは、当該分野において周知である。これらのデバイスは、固定された組織を切開するためのナイフを備え得る。
腹腔鏡構成または内視鏡構成を有するこのようなステープラーもまた当該分野で周知である。このタイプの内視鏡外科用ステープラーの例は、米国特許第6,330,965号、同第6,250,532号、同第6,241,139号、同第6,109,500号および同第6,079,606号(これらの全てが、その全体において参考として本明細書中で援用される)に記載される。
代表的には、このようなステープラーは、少なくとも2つの側方に間隔を空けた列に配置された複数のステープルを収容するためのステープルカートリッジ、およびステープルがカートリッジから駆動される場合にステープルのステープルレッグを受容し、そして形成するための複数のステープル形成ポケットを備えるアンビルを備える、一対のジョーを有するツール部材またはアセンブリを備える。アンビルおよびカートリッジは、互いに隣接して旋回可能に支持され、開位置と閉位置との間で互いに対して旋回可能である。使用において、組織は、開位置においてジョー間に位置付けられ、そしてジョーが、組織をそれらの間で、締め付けるために、閉位置に旋回する。
従来のステープラーおよびツールアセンブリと関連する1つの問題は、アンビルおよびカートリッジが互いに対して旋回する場合に、最初にジョーの近位端で閉鎖が生じ、その後、ジョーの遠位端で閉鎖が生じることである。ジョーの閉鎖のこの順序は、ジョーの遠位端に向かって、ジョー間に位置付けられた組織を動かし、従って、ジョーから組織を押す効果を有する。
腹腔鏡手順または内視鏡手順の間、外科部位へのアクセスは、小さな切開を介して、または患者の小さな入口の損傷を介して挿入される狭いカニューレを介して、達成される。外科用部位にアクセスするために利用可能な制限された領域のため、内視鏡ステープラーは、時々、組織を把持および/または操作するために使用される。閉位置に旋回可能である固定旋回点に取り付けられたアンビルまたはカートリッジを有する従来のステープラーは、ジョーの遠位端において制限された締め付け力のみを生じるので、組織を把持するためには特に適していない。
従って、ジョーの間に位置づけられた組織の遠位の動き無しにまたは遠位の動きを最小化しながら、ジョーの端部を用いること含め、組織を効果的に把持、操作、および/または固定するために操作され得る旋回ジョーを有する内視鏡外科用ステープリングツール部材またはアセンブリについての必要性が存在する。
(要旨)
本開示に従って、一対のジョーを有するツールアセンブリが、開示される。ジョーの各々が、近位端および遠位端を有し、第一のジョーが、間隔を空けた位置と接近した位置との間で、第二のジョーに対して可動である。第一のカム従動子および第二のカム従動子は、第一のジョーに支持される。接近部材は、第一のジョーに対して可動であり、第一のカム従動子および第二の従動子を係合するように位置付けられた少なくとも1つのカム表面を備える。接近部材は、第一のカム従動子および第二のカム従動子に対して少なくとも1つのカム表面を移動させて、間隔を空けた位置から接近位置への第一のジョーおよび第二のジョーの移動をもたらすために、第一のジョーに対して可動である。少なくとも一つのカムチャネルは、第一のジョーおよび第二のジョーの近位端の接近の前に、第一のジョーおよび第二のジョーの遠位端を接近させるように構成される。第一のジョーおよび第二のジョーの遠位端を接近させることによって、最初にジョーの間に位置づけられる組織は、ジョーの閉鎖の間にジョー内で推し進められない。さらに、ジョーは、ジョーの遠位端を使用して、組織をより良く、把持および操作し得る。
本開示に従って、一対のジョーを有するツールアセンブリが、開示される。ジョーの各々が、近位端および遠位端を有し、第一のジョーが、間隔を空けた位置と接近した位置との間で、第二のジョーに対して可動である。第一のカム従動子および第二のカム従動子は、第一のジョーに支持される。接近部材は、第一のジョーに対して可動であり、第一のカム従動子および第二の従動子を係合するように位置付けられた少なくとも1つのカム表面を備える。接近部材は、第一のカム従動子および第二のカム従動子に対して少なくとも1つのカム表面を移動させて、間隔を空けた位置から接近位置への第一のジョーおよび第二のジョーの移動をもたらすために、第一のジョーに対して可動である。少なくとも一つのカムチャネルは、第一のジョーおよび第二のジョーの近位端の接近の前に、第一のジョーおよび第二のジョーの遠位端を接近させるように構成される。第一のジョーおよび第二のジョーの遠位端を接近させることによって、最初にジョーの間に位置づけられる組織は、ジョーの閉鎖の間にジョー内で推し進められない。さらに、ジョーは、ジョーの遠位端を使用して、組織をより良く、把持および操作し得る。
好ましくは、第一のジョーは、アンビルを備え、そして第二のジョーは、複数のステープルを収容するカートリッジアセンブリを備える。好ましい実施形態において、少なくとも1つのカム表面は、第一のカムチャネルおよび第二のカムチャネルを備え、接近部材は、中に形成されたカムチャネルを有する平坦なプレートを備える。第一のジョーは、その近位端に形成された長手方向スロットを備え、接近部材が、この長手方向スロットにスライド可能に位置付けられる。第一のカム従動子および第二のカム従動子は、第一のジョーの近位端上に支持され、そして第一のカムチャネルおよび第二のカムチャネルに隣接した長手方向スロットを超えて延びる。第一のカム従動子が、第一のカムチャネルを通って延び、そして第二のカム従動子が、第二のカムチャネルを通って延びる。好ましくは、ツールアセンブリは、関節(articulation joint)によって本体部分に旋回可能に取り付けられる。本体部分は、外科用ステープリングデバイスの遠位端または使い捨て装填ユニットの近位端を形成し得る。
別の好ましい実施形態において、ツールアセンブリは、アンビル、複数のステープルを収容するカートリッジアセンブリおよび動的締め付け部材を備える。アンビルおよびカートリッジアセンブリは、間隔を開けた位置と接近位置とに間で互いに対して可動である。動的締め付け部材は、ステープルをカートリッジアセンブリから出すために、アンビルおよびカートリッジアセンブリに対して可動である。ツールアセンブリは、本体部分に旋回可能に取り付けられ、本体部分の長手方向軸と整列した位置から、本体部分の長手方向軸に対して一定の角度に向いた位置へ、本体部分に対して旋回可能である。関節および発射アクチュエータが、本体部分およびツールアセンブリを少なくとも部分的に通って延びる。関節および発射アクチュエータが、動的締め付け部材およびツールアセンブリと作動可能に関連し、本体部分に対してツールアセンブリを選択可能に旋回し、そして/またはカートリッジアセンブリからステープルを出すためにツールアセンブリに対して動的締め付け部材を移動させるために、それらに対する関係で可動である。
好ましくは、関節および発射アクチュエータは、第1末端部分、中心部分および第二末端部分を有する可撓性バンドを備え、第1末端部分が、本体部分を少なくとも部分的に通り、そしてカートリッジアセンブリを通って延び、中心部分が、第1末端部分から延び、動的締め付け部材と作動可能に関連し、そして第2末端部分が、中心部分から、カートリッジアセンブリを通り、そして該本体部分を少なくとも部分的に通り、第1末端に隣接した位置に延びる。関節および発射アクチュエータは、ツールアセンブリと作動可能に関連し、その結果、他の端部の近位への独立した、可撓性バンドの第1末端部分または第2末端部分のいずれかの移動が、本体部分に対してツールアセンブリの旋回をもたらし、そして可撓性バンドの第1末端部分および第2末端部分の両方の動きが、カートリッジアセンブリからステープルを出すための動的締め付け部材の移動を同時にもたらす。好ましい実施形態において、接近部材は、ツールアセンブリと作動可能に関連し、そしてアンビルおよびカートリッジアセンブリを間隔を空けた位置から接近位置へと移動させるために、ツールアセンブリに対して可動である。
すなわち、本発明は以下を特徴とする。
(項目1)
外科用デバイスであって、以下:
ツールアセンブリであって、該ツールアセンブリは、第一のジョーおよび第二のジョーを含み、該ジョーの各々が、近位端および遠位端を有し、該第一のジョーが、間隔を空けた位置と接近した位置との間で、該第二のジョーに対して可動である、ツールアセンブリ;
該第一のジョーおよび第二のジョーの1つのジョーに支持された、第一のカム従動子および第二のカム従動子、
接近部材であって、該第一のカム従動子および第二のカム従動子を係合するように位置付けられた少なくとも1つのカム表面を備え、該接近部材は、該第一のカム従動子および第二のカム従動子に対して少なくとも1つのカム表面を移動させるように可動であり、該間隔を空けた位置と該接近位置との間で該第一ジョーおよび第二ジョーの動きをもたらす、接近部材;ならびに
動的締め付け部材であって、該動的締め付け部材が、該第一のジョーおよび第二のジョーと作動可能に連結し、そして該ツールアセンブリを作動し、該動的締め付け部材に近接した位置において該第一のジョーと第二のジョーとの間で所望のギャップを維持するように、該第一のジョーおよび第二のジョーに対して可動である、動的締め付け部材、
を備える、外科用デバイス。
(項目2)
項目1に記載の外科用デバイスであって、前記第一のジョーが、アンビルを備え、前記第二のジョーが、複数のステープルを有するカートリッジアンブリを備え、前記動的締め付け部材が、該カートリッジアセンブリから複数のステープルを出すために該カートリッジアセンブリに対して可動である、外科用デバイス。
(項目3)
項目2に記載の外科用デバイスであって、前記動的締め付け部材が、前記カートリッジアセンブリをスライド可能に係合するために、前記アンビルおよび下側フランジをスライド可能に係合するように配置された上側フランジを備える、外科用デバイス。
(項目4)
項目3に記載の外科用ステープリングデバイスであって、前記第一のカム従動子および第二のカム従動子が、前記アンビルの近位端上に支持される、外科用ステープリングデバイス。
(項目5)
項目1に記載の外科用ステープリングデバイスであって、前記少なくとも1つのカム表面が、前記第一のジョーおよび前記第二のジョーの近位端の接近の前に、該第一のジョーおよび該第二のジョーの遠位端に接近するように構成されている、外科用ステープリングデバイス。
(項目6)
項目1に記載の外科用ステープリングデバイスであって、本体部分をさらに備え、前記ツールアセンブリが、関節によって該本体部分に旋回可能に取り付けられる、外科用ステープリングデバイス。
(項目7)
項目6に記載の外科用ステープリングデバイスであって、前記本体部分が、外科用ステープリングデバイスの遠位端を形成する、外科用ステープリングデバイス。
(項目8)
項目6に記載の外科用ステープリングデバイスであって、前記本体部分が、使い捨て装填ユニットの近位部分を形成する、外科用ステープリングデバイス。
(項目9)
項目6に記載の外科用ステープリングデバイスであって、さらに前記本体部分および前記ツールアセンブリを少なくとも部分的に通って延びる関節および発射アクチュエータを備え、該関節および発射アクチュエータが、前記動的締め付け部材および該ツールアセンブリと作動可能に関連し、該本体部分に対して該ツールアセンブリを選択可能に旋回し、そして該カートリッジからステープルを出すために該ツールアセンブリに対して該動的締め付け部材を移動させるために、それらに対する関係で移動可能である、
外科用ステープリングデバイス。
(項目1)
外科用デバイスであって、以下:
ツールアセンブリであって、該ツールアセンブリは、第一のジョーおよび第二のジョーを含み、該ジョーの各々が、近位端および遠位端を有し、該第一のジョーが、間隔を空けた位置と接近した位置との間で、該第二のジョーに対して可動である、ツールアセンブリ;
該第一のジョーおよび第二のジョーの1つのジョーに支持された、第一のカム従動子および第二のカム従動子、
接近部材であって、該第一のカム従動子および第二のカム従動子を係合するように位置付けられた少なくとも1つのカム表面を備え、該接近部材は、該第一のカム従動子および第二のカム従動子に対して少なくとも1つのカム表面を移動させるように可動であり、該間隔を空けた位置と該接近位置との間で該第一ジョーおよび第二ジョーの動きをもたらす、接近部材;ならびに
動的締め付け部材であって、該動的締め付け部材が、該第一のジョーおよび第二のジョーと作動可能に連結し、そして該ツールアセンブリを作動し、該動的締め付け部材に近接した位置において該第一のジョーと第二のジョーとの間で所望のギャップを維持するように、該第一のジョーおよび第二のジョーに対して可動である、動的締め付け部材、
を備える、外科用デバイス。
(項目2)
項目1に記載の外科用デバイスであって、前記第一のジョーが、アンビルを備え、前記第二のジョーが、複数のステープルを有するカートリッジアンブリを備え、前記動的締め付け部材が、該カートリッジアセンブリから複数のステープルを出すために該カートリッジアセンブリに対して可動である、外科用デバイス。
(項目3)
項目2に記載の外科用デバイスであって、前記動的締め付け部材が、前記カートリッジアセンブリをスライド可能に係合するために、前記アンビルおよび下側フランジをスライド可能に係合するように配置された上側フランジを備える、外科用デバイス。
(項目4)
項目3に記載の外科用ステープリングデバイスであって、前記第一のカム従動子および第二のカム従動子が、前記アンビルの近位端上に支持される、外科用ステープリングデバイス。
(項目5)
項目1に記載の外科用ステープリングデバイスであって、前記少なくとも1つのカム表面が、前記第一のジョーおよび前記第二のジョーの近位端の接近の前に、該第一のジョーおよび該第二のジョーの遠位端に接近するように構成されている、外科用ステープリングデバイス。
(項目6)
項目1に記載の外科用ステープリングデバイスであって、本体部分をさらに備え、前記ツールアセンブリが、関節によって該本体部分に旋回可能に取り付けられる、外科用ステープリングデバイス。
(項目7)
項目6に記載の外科用ステープリングデバイスであって、前記本体部分が、外科用ステープリングデバイスの遠位端を形成する、外科用ステープリングデバイス。
(項目8)
項目6に記載の外科用ステープリングデバイスであって、前記本体部分が、使い捨て装填ユニットの近位部分を形成する、外科用ステープリングデバイス。
(項目9)
項目6に記載の外科用ステープリングデバイスであって、さらに前記本体部分および前記ツールアセンブリを少なくとも部分的に通って延びる関節および発射アクチュエータを備え、該関節および発射アクチュエータが、前記動的締め付け部材および該ツールアセンブリと作動可能に関連し、該本体部分に対して該ツールアセンブリを選択可能に旋回し、そして該カートリッジからステープルを出すために該ツールアセンブリに対して該動的締め付け部材を移動させるために、それらに対する関係で移動可能である、
外科用ステープリングデバイス。
ジョーの間に位置づけられた組織の遠位の動き無しにまたは遠位の動きを最小化しながら、ジョーの端部を用いること含め、組織を効果的に把持、操作、および/または固定するために操作され得る旋回ジョーを有する内視鏡外科用ステープリングツール部材またはアセンブリを提供することができる。
(好ましい実施形態の詳細な説明)
ステープリングデバイスのための本開示のツールアセンブリの好ましい実施形態は、ここで、図面を参照して詳細に記載され、類似の参照数字は、いくつかの図面のぞれぞれにおいて、同一の要素または対応する要素を指定する。
ステープリングデバイスのための本開示のツールアセンブリの好ましい実施形態は、ここで、図面を参照して詳細に記載され、類似の参照数字は、いくつかの図面のぞれぞれにおいて、同一の要素または対応する要素を指定する。
図1〜3は、外科用ステープリングデバイスとともに使用するために、一般的に10として示される、本開示のツールアセンブリの一つの好ましい実施形態を示す。ツールアセンブリ10は、アンビル12およびカートリッジアセンブリ14を備える一対のジョー、ならびに接近アセンブリ16を備える。カートリッジアセンブリ14は、ステープルカートリッジ14aを受容するための支持チャネル18を備える。支持チャネル18は、遠位解放チャネル部分18aおよび切断円筒18cを規定する近位部分18bを備える。詳細には示さないが、ステープルカートリッジ14aは、複数のステープルを収容し、そしてカートリッジ14aの組織係合表面25の開口またはスロットを通してステープルを移動させるために、スレッド(例えば、図6において131)を代表的に備えるステープル駆動アセンブリの平行移動のための従来のプッシャー(図示せず)を備え得る。
アンビル12は、遠位端20aおよび近位端20bを有する組織係合表面20ならびに近位本体部分22を有する。長手方向スロット24は、組織係合表面20を通ってアンビル12の中心長手方向軸に沿って伸長し、駆動アセンブリの一部をスライド可能に受容するような寸法である。駆動アセンブリは、代表的に、駆動バー、閉鎖アセンブリ、スレッド、および複数のプッシャーを備える。駆動アセンブリは、カートリッジからステープルを出すように機能し、好ましくは、また、デバイスの発射の間、カートリッジとアンビルとの間で所望の均一な組織の隙間を維持する。アンビル12の近位本体部分22は、一般的に、支持チャネル18の近位部分18bの切断円筒18c内に旋回可能に受容されるような寸法であり、その結果、アンビル12の組織係合表面20は、カートリッジ14aの組織係合表面25から間隔を開けた位置から、隣接して整列した接近位置へ旋回可能である。
ツールアセンブリ10は、一つ以上のカムチャネル28および30を有する接近部材16を備える。好ましくは、接近部材は、一対のカムチャネルを備えるが、一対のカム表面を有する単一のカムチャネルが想定される。接近部材16は、チャネル18の近位部分18bを通り、アンビル12の近位本体部分22に形成されるスロット22aを通って、線形にスライド可能な寸法である。カム従動子32は、アンビル12の近位部分22に形成されるボア34を通り、そして支持チャネル18bの近位部分18bの穴35をとって延び、カムチャネル28内に位置づけられる。カム従動子36は、アンビル12の近位部分22に形成される第二ボア38を通り、そして近位部分の穴39を通って延び、そしてカムチャネル30内に位置づけられる。接近部材16が、アンビル12の近位部分22のスロット22aを通って進む場合、カム従動子32および36は、それぞれ、カムチャネル28および30を通って移動する。接近部材16がスロット22a内での線形運動に制限されるので、遠位方向での接近部材16の動きは、開位置または間隔を開けた位置から、閉位置または接近位置へのアンビル12の旋回の動きをもたらす。カムスロットの角度は、機械的利点を改善し、そして特定の結果(例えば、組織を把持する)を達成するために種々の接近の動きを提供するように構成され得る。
図4A〜4Cをまた参照して、カムチャネル28および30は、好ましくは、最初に、組織の把持を容易にし、その後、アンビルおよびカートリッジアセンブリの実質的に平行な閉鎖を提供するために、制御された様式で、アンビル12を開位置(図14A)からカートリッジアセンブリ14に向かって旋回させるように構成される。さらに詳細には、カムチャネル28および30は、好ましくは、接近部材16の作動ストロークの初期部分の間、カートリッジ14と実質的に接触して、アンビル12の組織接触表面20の遠位端20aを位置づけるように構成される(図4B)。これは、非常に薄い組織でさえ、組織の把持を容易にする。接近部材16の作動ストロークの第二の部分の間、アンビル12の遠位端20aは、カートリッジアセンブリ14から離れて、アンビル12の組織係合表面20がカートリッジアセンブリ14の組織係合表面25に平行または実質的に平行な結果として生じる位置へ移動する。接近部材16の作動ストロークの最終の部分の間、アンビル12およびカートリッジアセンブリ14は、所望の組織隙間を規定するために、平行または実質的に平行な閉鎖で一緒になる(図4C)。アンビル12の任意の所望の動きは、本明細書中に記載されるカム従動子を使用して達成され得ることに留意のこと。アンビル12をカートリッジアセンブリ14に対して、間隔を開けた位置から接近位置へ、上記様式(すなわち、前方または遠位から後方または近位閉鎖へ)で移動することによって、従来のデバイスのように、ジョー内で組織が前方に移動する傾向は、実質的に除かれる。
接近部材16が2つの異なるカムチャネルを有するプレートの形態で示されるが、異なる構成の接近部材が想定される。例えば、単一のカムチャネルは、2つのカム従動子を係合するように提供され得る。さらに、カムチャネルは、制限される必要はなく、むしろ、プレート、棒などの表面で形成され得る。このようなデバイスにおいて、アンビルは、閉鎖位置または締め付け位置に付勢部材によって押され得る。
一つ以上のアクチュエーターが、接近部材を進めるため、および/またはカートリッジアセンブリからステープルを発射するために開示されていないが、一つ以上の種々の公知の旋回可能、回転可能、またはスライド可能アクチュエーター(例えば、トリガー、ノブ、レバーなど)が、本開示のカートリッジアセンブリを接近させるため、および/またはカートリッジアセンブリからステープルを発射するために使用され得ることが想定される。開示されるツールアセンブリが、使い捨て装填ユニットの遠位部分であり得るかまたは遠位部分を形成し得、あるいは、外科用器具(例えば、外科用ステープラー)の遠位端に直接組み込まれ得、そして置換可能なカートリッジアセンブリを備え得ることが留意される。
図5〜10は、100として一般的に示される本開示のツールアセンブリの別の好ましい実施形態を開示する。ツールアセンブリ100は、アンビル112およびカートリッジアセンブリ114、接近部材116、ならびに122として一般的に参照される関節を備える細長本体部分120を備える。細長本体部分120は、使い捨て装填ユニットの近位端または外科用ステープリングデバイスの遠位端を形成し得る。ツールアセンブリ100はまた、関節122の回りでツールアセンブリ100の関節の動きを行わせ、ステープルをカートリッジアセンブリ114から出すための組み合わせ関節および発射作動機構124を備える。関節が予め形成された曲げ領域を有する可撓性の波形部材として示されるが、関節122は、関節(articulation)を提供する任意の公知の型の関節(joint)(例えば、旋回ピン、ボールソケット関節、ユニバーサルジョイントなど)を含み得る。
接近部材116は、接近部材16と実質的に類似であり、また、カムチャネル128および130を備える(図7)。接近部材116は、さらに、一対のガイドチャネル126を備える。ガイドチャネル126は、細長本体部分120を通って延び、そして進行の直線経路に沿って、接近部材116を維持するように機能するガイドピン128を受容するような寸法である。接近部材116は、可撓性材料(例えば、関節122の回りで曲がり得る、バネスチール)から構築される。あるいは、接近部材116が、カム表面が形成された弾性ロッド、バンドなどを備え得ることが想定される。接近部材116は、接近部材16と実質的に同じ様式であり、本明細書中でさらに詳細に考察しない。
カートリッジアセンブリ114は、支持チャネル118、スレッド131および動的締め付け部材132を備え、この動的締め付け部材132は、好ましくは、アンビルのベアリング表面をスライド可能に係合するための上側フランジ134aおよびカートリッジのベアリング表面をスライド可能に係合するための下側フランジ134bを備える。ナイフの刃134は、好ましくは、組織を切開するために、動的締め付け部材132の中心部分134cに支持される。ナイフの刃は、除去可能な様式または固定した様式で動的締め付け部材132を固定され得るか、一体的に形成され得るか、あるいは動的締め付け部材132へと直接研がれ得る。スレッド131は、カートリッジからステープルを出すために、公知の様式で、カートリッジ114を通って移動するように、スライド可能に位置づけられる。スレッド131などは、動的締め付け部材132と一体的またはモノリシックであり得る。スレッド131は、動的締め付け部材132の遠位に位置づけられ、動的締め付け部材132と係合し、そして動的締め付け部材132によって押される。131の位置は、ステープルされる組織を切断する前に、組織を固定するためにステープルの発射をもたらすかまたは出すためである。フランジ134bは、好ましくは、カートリッジ114の基部に形成される凹部138内に位置づけられる。フランジ134aは、好ましくは、アンビル112に形成される単一の凹部または別々の凹部内に位置づけられる。また、フランジ134aおよび134bは、凹部に位置づけられる必要はないが、アンビルおよびカートリッジのそれぞれの表面にスライド可能に係合し得る。動的締め付け部材132は、好ましくは、カートリッジアセンブリ114内でスレッド130の近位に位置づけられる。動的締め付け部材132は、ステープルの発射の間、スレッド130に隣接するツールアセンブリ100の領域に所望の組織の隙間を提供し、回復し、そして/または維持するように機能する。
アンビルおよび好ましくは、動的締め付け部材が、1つの材料から形成され、デバイスの発射の間、アンビルおよび動的締め付け部材の曲がりを最小にするような厚みであることが好ましい。このような材料としては、外科用グレードのステンレス綱が挙げられる。アンビルは、好ましくは、中実ユニットとして形成される。あるいは、アンビルは、従来の構成要素を有する部品のアセンブリから形成され得る。
図6、9、および10を参照して、関節および発射機構124は、ループ124または一つ以上のアクチュエーターまたは作動機構の適切な接続部材への接続のための他の接続部分またはコネクタを有し得る、張力部材140を備える。可撓性バンドとして示されるが、張力部材140は、必要とされる強度要件を有し、以下に記載される機能を実行し得る任意の可撓性駆動部材の一つ以上(例えば、編まれたまたは織られたストラップまたはケーブル、ポリマー材料、パラ−アラミド(例えば、KevlarTMなど)であり得るかまたはこれらを含み得る。KevlarTMは、DuPontから市販されるポリ−フェニレンテレフタルアミドの商品名である。一対の適切な固定または回転可能部材(好ましくは、ローラー142aおよび142b)は、カートリッジアセンブリ114の遠位端に固定される。ローラー142aおよび142bは、カートリッジアセンブリ114の除去可能キャップ114b(図6)に形成されるかまたは支持され得る。あるいは、キャップ114bは、ステープルカートリッジ114aまたはカートリッジチャネル118と一体的に形成され得る。ローラー142aおよび142bはまた、カートリッジ支持チャネル118に固定され得るかまたはカートリッジ支持チャネル118から形成され得る。張力部材140は、ツールアセンブリ100の細長本体120から遠位に、ステープルカートリッジ114aの末梢チャネル142を通って遠位に、ローラー142aの回り、近位、好ましくは、カートリッジ114aに形成される中心長手方向スロット144のそばに、スロット200(好ましくは、横スロット)通って、動的締め付け部材132においてまたはその周りで、ローラー142の周りで遠位に、そして再びカートリッジ114aに形成されるチャネル146を通って、細長本体120の近位部分へと近位に延びる。あるいは、2つの張力部材が使用され得、そのそれぞれが、動的締め付け部材132に固定され得る。図10に示されるように、チャネル142および146は、カートリッジ114aの内壁および/または外壁によって、ならびに/あるいはカートリッジ支持チャネル118によって、少なくとも部分的に規定され得る。示されるものとは異なるが、チャネル142および146は、一定(すなわち、ステープルカートリッジの両側で機能的に同じまたは対応する位置)である。従って、2つの末梢チャネル142、または2つのチャネル146が存在することが想定される。
使用において、張力部材140の第一端部または部分150が、図9に示されるように、矢印「A」によって示される方向で、適切な手段によって引っ張られる場合、ツールアセンブリ100は、矢印「D」によて示される方向で旋回部材122aの周りで関節の動きを行う。張力部材140の第二端部または部分152が、矢印「B」によって示される方向で、引っ張られる場合、ツールアセンブリ100は、矢印「C」によて示される方向で関節の動きを行う。張力部材140の両方の端部が同時に引っ張られる場合、張力部材140は、カートリッジ114aのスロット144を通って遠位に動的締め付け部材132を進めて、動的締め付け部材132およびスレッド130をカートリッジ114aを通して進め、プッシャーに係合することによって、カートリッジからステープルを出し、そして組織隙間の組織を切開する。ツールアセンブリが関節の動きを行った場合(すなわち、張力部材140の一つの端部のみが引っ張られた場合)、動的締め付け部材132が、スロット144を通って進むことを妨げるために、ロックアウトデバイス(図示しない)(例えば、剪断ピン)が、動的締め付け部材の動きを妨げるか、または所定の力が動的締め付け部材132に適用されるまでその動きを遅延させるために適用され得る。複数の張力部材(例えば、バンド)が使用され得、それぞれ、個々の機能または機能の組み合わせを実行することが想定される。例えば、一対の張力部材が使用され得、一方が関節であり、他方が、接近、締め付けおよび発射であり得る。張力部材は、動的締め付け部材またはナイフ保持部材、あるいは動的締め付け部材、ナイフ部材および/またはスレッド部材の組み合わせに固定され得る。
上記ツールアセンブリは、米国特許第6,330,965号に記載のような使い捨て装填ユニットに組み込まれ得るか、または任意の公知の外科用ステープリングデバイスの遠位端に直接取り付けられ得る。接近部材および組み合わせ関節発射機構を作動させるためのハンドルアセンブリは、本明細書中に具体的に開示されていないが、幅広い種々の作動機構およびハンドル(トグル、回転可能およびスライド可能ノブ、回転可能レバーまたはトリガー、ピストルグリップ、インラインハンドル、遠隔操作システムおよびこれらの任意の組み合わせを含む)の使用が、想定されることが理解される。ロボットシステムの一部としての上記ツールアセンブリの使用が想定される。
種々の改変が、本明細書中に開示される実施形態に対してなされ得ることが理解される。例えば、この出願が主に外科用ステープラーの使用に焦点を当てているが、他の固定デバイス(例えば、ツーパートファスナー)がこのデバイスに含まれ得る。ツーパートファスナーが使用されるデバイスにおいて、アンビルステープル形成ポケットのそれぞれが、ツーパートファスナーの一つの部分を受容するように構成され得る。さらに、本開示において提供される教示が、グラスパーを含むステープリングデバイスを以外の外科用デバイスに組み込まれ得ることが想定される。従って、上記は、制限として解釈されず、好ましい実施形態の単なる例示として解釈されるべきである。当業者は、本明細書に添付の特許請求の範囲の範囲および精神の範囲内の他の改変を想定する。
外科用ステープリングデバイスとともに使用するための本開示のツールアセンブリの種々の好ましい実施形態は、図面を参照して、本明細書中で開示される。
10 ツールアセンブリ
12 アンビル
14 カートリッジアセンブリ
14a ステープルカートリッジ
16 接近アセンブリ
18 支持チャネル
12 アンビル
14 カートリッジアセンブリ
14a ステープルカートリッジ
16 接近アセンブリ
18 支持チャネル
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- 図面に示すような外科用デバイス。
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2003
- 2003-10-06 DE DE60319443T patent/DE60319443T2/de not_active Expired - Lifetime
- 2003-10-06 ES ES03770659T patent/ES2289334T3/es not_active Expired - Lifetime
- 2003-10-06 CA CA2712039A patent/CA2712039C/en not_active Expired - Fee Related
- 2003-10-06 US US10/529,568 patent/US7617961B2/en active Active
- 2003-10-06 JP JP2004543422A patent/JP4448449B2/ja not_active Expired - Fee Related
- 2003-10-06 EP EP06003688A patent/EP1671593B1/en not_active Expired - Fee Related
- 2003-10-06 AU AU2003279152A patent/AU2003279152B2/en not_active Expired
- 2003-10-06 EP EP03770659A patent/EP1545332B1/en not_active Expired - Fee Related
- 2003-10-06 CA CA2500796A patent/CA2500796C/en not_active Expired - Fee Related
- 2003-10-06 ES ES06003688T patent/ES2300076T3/es not_active Expired - Lifetime
- 2003-10-06 WO PCT/US2003/031653 patent/WO2004032754A2/en active IP Right Grant
- 2003-10-06 DE DE60315846T patent/DE60315846T2/de not_active Expired - Lifetime
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2009
- 2009-03-11 AU AU2009200962A patent/AU2009200962B2/en not_active Expired
- 2009-10-28 US US12/607,637 patent/US7857184B2/en active Active
- 2009-11-20 JP JP2009265748A patent/JP2010042295A/ja active Pending
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2010
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2011
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Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
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JP2014514012A (ja) * | 2011-03-01 | 2014-06-19 | エシコン・エンド−サージェリィ・インコーポレイテッド | 多速度方向切替機構を有する外科用器具 |
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JP2006501955A (ja) | 2006-01-19 |
EP1545332B1 (en) | 2007-08-22 |
WO2004032754A2 (en) | 2004-04-22 |
JP4448449B2 (ja) | 2010-04-07 |
CA2500796C (en) | 2011-03-15 |
ES2300076T3 (es) | 2008-06-01 |
DE60315846D1 (de) | 2007-10-04 |
DE60319443D1 (de) | 2008-04-10 |
US20110036893A1 (en) | 2011-02-17 |
US20130015233A1 (en) | 2013-01-17 |
US7617961B2 (en) | 2009-11-17 |
EP1671593B1 (en) | 2008-02-27 |
US20060100644A1 (en) | 2006-05-11 |
US8616427B2 (en) | 2013-12-31 |
AU2009200962A1 (en) | 2009-04-02 |
DE60319443T2 (de) | 2009-02-19 |
US8091753B2 (en) | 2012-01-10 |
AU2009200962B2 (en) | 2011-10-06 |
EP1671593A1 (en) | 2006-06-21 |
EP1545332A2 (en) | 2005-06-29 |
AU2003279152B2 (en) | 2008-12-11 |
DE60315846T2 (de) | 2008-05-21 |
WO2004032754A3 (en) | 2004-07-01 |
CA2712039C (en) | 2013-03-12 |
US8292151B2 (en) | 2012-10-23 |
US20100044411A1 (en) | 2010-02-25 |
ES2289334T3 (es) | 2008-02-01 |
US7857184B2 (en) | 2010-12-28 |
US20120091184A1 (en) | 2012-04-19 |
AU2003279152A1 (en) | 2004-05-04 |
CA2500796A1 (en) | 2004-04-22 |
CA2712039A1 (en) | 2004-04-22 |
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